Inservice Deck 1 - CV and ENT

Question 1

Immediate tx for unstable patient with pulses?

Answer 1

synchronized cardioversion @ 100J

Question 2

procainamide - 2 main indications

4 stopping points

Answer 2

WPW and VTach

Hypotension
Resolution of arrhythmia
QRS widening > 50% original
Max dose reached (17 mg/kg)

Question 3

Hepatojugular reflux indicates?

Answer 3

right sided heart failure

Question 4

What do you think of with electrical alternans?

Answer 4

cardiac tamponade (pericardial effusion)

Question 5

Best way to visualize the vegetations in endocarditis?

Answer 5

TEE

gold std - tissue biopsy

Question 6

most useful test for endocarditis?

Answer 6

blood cxs x 3, taken 1 hour apart

Question 7

Number 1 complication of endocarditis?

Answer 7

CHF

Question 8

Most sensitive CXR finding in aortic dissection?

Answer 8

widened mediastinum

Question 9

Sudden onset of sharp chest pain and back pain, syncope, or stroke-like symptoms think?

Answer 9

aortic dissection

Question 10

initial treatment for hemodynamically stable patient with prolonged qt who develops tachyarrhythmia

Answer 10

mg

Question 11

normally functioning pacemaker fails to pace, most likely cause

Answer 11

oversensing

• pacemaker senses external stimuli as atria/vent contraction

Question 12

ekg in pericarditis will most commonly show ST elevations and what else?

Answer 12

PR depression

Question 13

tx for patient with ST elevations in II, III, and aVF who develop hypotension?

Answer 13

IV fluid bolus

• inferior MI think right ventricle involved

Question 14

most common sign in patient with myocarditis?

Answer 14

tachycardia

Question 15

most specific sign in acute CHF?

Answer 15

S3

Question 16

Patient had MI 2 months ago and has EKG with persistent ST elevation. What is the diagnosis?

Answer 16

ventricular aneurysm

Question 17

tx for asymptomatic patient with PVCs?

Answer 17

observe / DC if incidental finding

Question 18

10 year old has signs and symptoms of CHF as well as HTN and unequal pulses. Most likely cause?

Answer 18

coarctation of the aorta

Question 19

dialysis patient presents with dyspnea. You press on his AV gract and the pulse drops from 130-90. What does this indicate?

Answer 19

high output failure

Branham sign - may occur when > 20% of cardiac output is diverted through the access

Question 20

Disposition for patient with abd pain and 7 cm pulsatile mass?

Answer 20

operating room

• no CT, ruptured AAA

Question 21

What are the contraindications to thrombolytics in patients with ACS?

Answer 21

TPA IS BAD

T - trauma
P - pericarditis
A - active internal bleeding
I - intracranial pathology/tumor
S - stroke - hemorrhagic or recent ischemic (6 months)
B - BP uncontrolled, 180 or above SBP or 11 DBP
A - allergic to med
D - dissection (suspected)

Question 22

what ST/T ratio can distinguish benign early repolarization from pericarditis?

Answer 22

ST/T < 0.25 in benign early repol

Question 23

Female with palpitations and mid systolic click has what diagnosis?

Answer 23

mitral valve prolapse

Question 24

most common cause of dysr4hythmia in cardiac transplant patient?

Answer 24

rejection

Question 25

patient s/p cardiac transplant has bradycardia. WHat med will not be effective? why not?

Answer 25

atropine - denervated vagal nerve

Question 26

Next test to order on 65 year old male with HTN, left flank/back pain, and trace hematuria?

Answer 26

abd ultrasound - r/o AAA

Question 27

What tx is indicated for patient with unstable angina allergic to ASA?

Answer 27

clopidogrel

Question 28

patient with transvenous pacer has pacer spikes with LBBB pattern on EKG. WHat does this signify?

Answer 28

functioning normally

Question 29

a magnet placed over a pacemaker has what effect?

Answer 29

causes it to fire at a fixed rate

Question 30

30 year old male presents after syncopal event with EKG showing ST elevatioin in V1-V3 with a RBBB without reciprocal depressions. Most likely diagnosis?

Answer 30

brugada syndrome tx - refer for EPS study

Question 31

What is the best tooth transplant medium? what if not available?

Answer 31

Hank's balanced salt solution - milk - saline - intraoral hanks - isotonic calcium containing cell culture medium

Question 32

bad breath and bad gums?

Answer 32

ANUG acute necrotizing ulcerative gingivitis

Question 33

What is the diagnosis and inital source that caused an abnl swelling in submandibular region with tongue deviated upward?

Answer 33

ludwig's angina odontogenic - caused from an abscess of the mandibular molars

Question 34

Organism that causes malignant otitis externa?

Answer 34

pseudomonas - classically in diabetics

Question 35

Common source of posterior epistaxis?

Answer 35

sphenopalatine artery

Question 36

patients most at risk for posterior bleeds?

Answer 36

elderly with coag

Question 37

diabetic presents with facial pain, unilateral facial swelling over the mandible, fever, trismus, purulent discharge from stetson's duct has what?

Answer 37

suppurative parotitis Cause - bact = staph viral = mumps tx - abx, sialogogues

Question 38

patient has acute onset of tinnitus hearing loss and vertigo, N/V, and nystagmus that is fatigable. No recent URI and has had multiple previous episodes. Diagnosis?

Answer 38

meniere's disease

Question 39

child has been coughing since playing with legos. What test is needed?

Answer 39

bronchoscopy after CXR

Question 40

Diagnosis and tx for baby with infection of lacrimal sac?

Answer 40

dacryocystitis tx - topical and systemic abx, ophtho consult, warm compresses

Question 41

3 year old immigrant with multipe episodes of paroxysms of coughing. Dx and tx?

Answer 41

pertussis tx - erythromycin or other macrolide

Question 42

are systemic abx indicated for most patients with dry socket

Answer 42

NO! tx - nerve block, irrigate, eugenol, +/- gelfoam

Question 43

What infection is of concern in diabetic febrile who develops black sputum?

Answer 43

mucormycosis

Question 44

what is the disposition and tx for a febrile patient who presents with posterior auricular pain and tenderness to touch

Answer 44

mastoiditis tx - admit with IV abx

Question 45

most common organism in otitis media?

Answer 45

strep pneumo

Question 46

most common complication of AOM?

Answer 46

tympanic membrane perforation